WHEN LUPUS STRIKES THE VESSELS: CONCURRENT CEREBRAL AND PULMONARY VASCULITIS AS THE INITIAL MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with protean clinical manifestations. Vasculitis represents a severe and potentially life-threatening complication, especially when involving critical organs such as the central nervous system and lungs. We report a rare case of a 41-year-old male who presented with acute neuropsychiatric manifestations, mucocutaneous bleeding, tremulousness, and pulmonary involvement, later diagnosed as SLE-associated small-vessel vasculitis with secondary antiphospholipid syndrome (APS).The patient presented with bleeding gums, altered behavior, tremors, unsteady gait, and new-onset seizures. Examination revealed oral ulcers, erythematous papules, cognitive impairment, and generalized weakness. MRI brain demonstrated bilateral multiple small infarcts suggestive of vasculitis, while CT chest showed centrilobular nodules with ground-glass opacities. Autoimmune work-up revealed ANA positivity (3+) and elevated anti-β2 glycoprotein I IgG, confirming SLE with APS. The patient showed dramatic clinical and radiological improvement following immunosuppression with corticosteroids and anticoagulation.This case underscores the importance of considering autoimmune vasculitis in patients with multisystem involvement and highlights the aggressive nature of SLE-related vasculitis in males.